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CNAA / Theses / 2007 / May /

Clinical, immunological pecularities and treatment optimization in acute C viral hepatitis in young and average persons


Author: Lilia Cojuhari
Degree:doctor of medicine
Speciality: 14.00.10 - Infections Diseases
Year:2007
Scientific adviser: Victor Pântea
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Gheorghe Cuşnir
doctor, associate professor (docent)
Institution:
Scientific council:

Status

The thesis was presented on the 30 May, 2007
Approved by NCAA on the 20 September, 2007

Abstract

Adobe PDF document0.29 Mb / in romanian

Thesis

CZU 616.36-002.1-053.8

Adobe PDF document 0.80 Mb / in romanian
113 pages


Keywords

Acute hepatitis, virus C, biochemical tests, immunological, epidemiological, clinical forms, syndrome, treatment, genotype, young and average, spectrum anti-CVH

Summary

This paper represents a complex research of the clinical and immunological pecularities and treatment optimization in acute C viral hepatitis according to the age. Which was performed on 113 patients: 72 young patients (I group) and 41 average (II group) acute CVH diagnosis was confirmed according to clinical, epidemiological, biochemical, serological (anti-CVH IgM presence, anti-CVHsum and anti-HCV spectrum by ELISA) data and polymerase chain reaction for ARN-VHC. At genotype determination acute CVH in studied patients, is causing by 1b (95,5%) type has been observed. Anti-HCV spectrum investigation, comparative with structural and unstructural proteins permits the early diagnosis of acute CVH and prognosis. Clinical manifestations in acute CVH patients according to age by astenovegetative, dispeptic and artralgic syndrom have been observed. The CVH acute patients from the Ist group the easy and moderate forms have been registered (94,4%) but in those from the IInd one – the moderate and severe (100%). More frequently antijaudice forms in the Ist group patients have been observed, comparatively with those from IInd one (40,3% and 19,5%) respectively). Average duration of jaudice period of CVH patients from the Ist group was 19,28±1,12 days but in the IInd - 28,24±1,97 days. The biochemical tests shows the bilirubin and activity ALAT increase in the both groups, being lower in the Ist group patients. The increase in rapid dynamics of these indexes in the Ist group patients have been registered comparativly with the IInd group. In treated patients after acute CVH, after 6 mounts of discharging ARN-VHC in blood serum in investigated one in 75% have not observed, but anti-CVH spectrum in 77% (antibodies absence in anti-NS4A-NS5 parts) that demonstrates the informative method for prognostic and it is accesible for every patients. After 12 mounts of monitorization by clinical and virusologic examination by PCR – ARN-VHC in 58,3% has not observed comparativly with 75% after 6 mounts. Immunological indexes in acute CVH patients in onset were characterized by following increase. The T-lymphocytes with number disturbance of T subpopulation with immunoregulation function and simultaneous increase of E active rossete formatory lymphocytes E and B termostabile a serical IgG concentration. These disturbances have a tendency of normalization in the IInd and in the IIIrd mounts of T cellular deficiency and immunosupresive situation in acute CVH convalescences after III mounts, constitutes the risc factors of chronic disease. Native Pacovirin administration, as anaditional remedy in the traditional treatment in experimental group comparative with control, leaded to the rapid disappea rance of clinical symptoms, biochemical and immunological indexes normalization, liver sizes and short term of patient hospitalization